Bone plate supported by a leg member and used as a lever

ABSTRACT

System, including apparatus and methods, for fixing bone with a bone plate supported temporarily at a slant on bone by a leg member before the bone plate is used as a lever to reposition a region of the bone. In some embodiments, the leg member may be a post member that attaches to the bone plate by threaded engagement with an aperture of the bone plate. In some embodiments, the bone plate and the leg member may be used near the end of a long bone, such as on a distal portion of a radial bone.

CROSS-REFERENCE TO PRIORITY APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/652,185, filed Oct. 15, 2012, now U.S. Pat. No. 9,414,871, which, inturn, is a continuation-in-part of U.S. patent application Ser. No.13/246,684, filed Sep. 27, 2011, now U.S. Pat. No. 8,425,575, which, inturn, is based upon and claims the benefit under 35 U.S.C. §119(e) ofU.S. Provisional Patent Application Ser. No. 61/386,925, filed Sep. 27,2010. Each of these priority patent applications is incorporated hereinby reference in its entirety for all purposes.

INTRODUCTION

The radius or radial bone is one of two long bones found in the humanforearm. The radius, like other bones, is susceptible to a variety offractures and deformities. For example, distal fractures of the radiusare a common result, particularly among the elderly, of forward fallswith the palms facing downward. In such falls, force exerted on thedistal radius at impact can produce dorsal displacement and rotation ofone or more bone fragments created distally to the fracture site.

Fixation of the fractured radius may be performed by internal fixationwith a bone plate. The bone plate may be secured on the volar (ordorsal) surface of the distal radius with fasteners, such as bone screwsor K-wires, among others. The bone plate may be pre-bent to follow thelongitudinal profile of the volar (or dorsal) surface of the radius.

A fractured distal radius, if not fixed properly, may heal in amisshaped configuration, such as with an incorrect amount of volar tiltat the distal articular surface. This deformity can cause arthritis andthe inability to rotate the wrist. To restructure the bone, a surgeonmay perform a corrective osteotomy. A distal portion of a bone plate maybe attached near the end of the radius, with a proximal portion of thebone plate forming a projecting arm extending at a slant above the shaftof the bone. The surgeon then may cut the bone at a position proximal tothe site of attachment to create a distal bone fragment. The distal bonefragment may be pivoted into a more anatomically correct position bymoving the projecting arm into contact with the shaft of the bone,followed by attachment of the arm to the shaft. However, a surgeongenerally must guess an orientation for attachment of the bone plate, toslant the arm of the bone plate above the shaft of the bone at an anglethat will provide a suitable angular correction. Also, the bone platetends to slip or shift during attachment of the distal portion of thebone plate near the end of the bone, which alters the orientation of thebone plate's arm.

Better approaches are needed to use a projecting arm of a bone plateeffectively to reposition a bone fragment.

SUMMARY

The present disclosure provides a system, including apparatus andmethods, for fixing bone with a bone plate supported temporarily at aslant on bone by a leg member before the bone plate is used as a leverto reposition a region of the bone. In some embodiments, the leg membermay be a post member that attaches to the bone plate by threadedengagement with an aperture of the bone plate. In some embodiments, thebone plate and the leg member may be used near the end of a long bone,such as on a distal portion of a radial bone.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of selected aspects of an exemplary embodiment ofa bone fixation system including a bone plate and a detachable legmember temporarily supporting an arm portion of the bone plate at aslant above a shaft of a fractured radial bone, in accordance withaspects of the present disclosure.

FIG. 2 is a top view of the bone plate and bone of FIG. 1 takengenerally along line 2-2 of FIG. 1 with the leg member removed.

FIGS. 3-7 are side views of exemplary leg members, structured as postmembers, for use in the system of FIG. 1, with the leg members designedto support an arm portion of the bone plate at a predefined angle ofabout 5°, 10°, 15°, 20°, and 25°, respectively, above a shaft surfaceregion of bone, in accordance with aspects of the present disclosure.

FIG. 8 is a side view of another exemplary leg member structured as apost member for use in the system of FIG. 1, with the leg memberdesigned to support an arm portion of the bone plate at a continuousrange of angles from about 0° to 30° above a shaft surface region ofbone, in accordance with aspects of the present disclosure.

FIGS. 9-13 are somewhat schematic configurations produced duringperformance of an exemplary method of fixing a fractured bone using thebone plate of FIG. 1 and the leg member of FIG. 8, in accordance withaspects of the present disclosure.

FIGS. 14-16 are somewhat schematic configurations produced duringperformance of an exemplary method of fixing a cut bone using the boneplate and leg member of FIG. 1, in accordance with aspects of thepresent disclosure.

DETAILED DESCRIPTION

The present disclosure provides a system, including apparatus andmethods, for fixing bone with a bone plate supported temporarily at aslant on bone by a leg member before the bone plate is used as a leverto reposition a region of the bone. In some embodiments, the leg membermay be a post member that attaches to the bone plate by threadedengagement with an aperture of the bone plate. In some embodiments, thebone plate and the leg member may be used near the end of a long bone,such as on a distal portion of a radial bone.

An exemplary method of bone fixation is provided. In the method, a boneplate including a first portion and a second portion may be selected. Aleg member may be disposed on the bone with the leg member attached toand projecting from the first portion of the bone plate to a firstregion of the bone, such that the first portion of the bone plate issupported at a slant with respect to the first region and spaced fromthe bone. The second portion of the bone plate may be attached to asecond region of the bone. The leg member may be disconnected from thebone plate. The first portion of the bone plate may be pivoted towardthe first region of the bone such that the bone plate is used as a leverto change an orientation of the second region relative to the firstregion of the bone. The first portion of the bone plate may be attachedto the first region of the bone.

Another exemplary method of bone fixation is provided. In the method, abone plate may be selected. The bone plate may include an elongated bodyportion connected to a head portion that is wider than the body portion.A leg member may be disposed on the bone with the leg member attached toand projecting from the body portion of the bone plate to a shaft regionof the bone, such that the body portion of the bone plate is supportedat a slant above the shaft region. The head portion of the bone platemay be attached to an end region of the bone. The leg member may bedisconnected from the bone plate. The body portion of the bone plate maybe pivoted toward the shaft region of the bone such that the bone plateis used as a lever to change an orientation of the end region relativeto the shaft region of the bone. The body portion of the bone plate maybe attached to the shaft region of the bone.

Yet another exemplary method of bone fixation is provided. In themethod, a bone plate may be selected. The bone plate may include an armportion, a fulcrum portion, and an anchor portion arranged in orderalong the bone plate. A post member may be disposed on the bone with thepost member extending through an aperture of the arm portion to a firstregion of bone and attached to the arm portion at the aperture, suchthat the fulcrum portion and the post member collectively support thearm portion in a spaced relation to the bone and at a slant with respectto the first region of the bone. The anchor portion of the bone platemay be attached to a second region of the bone. The leg member may bedisconnected from the bone plate. The arm portion of the bone plate maybe pivoted toward the first region of the bone such that the bone plateis used as a lever to change an orientation of the second regionrelative to the first region of the bone. The arm portion of the boneplate may be attached to the first region of the bone.

An exemplary system for bone fixation is provided. The system maycomprise a bone plate including an arm portion and an anchor portionseparated from the arm portion by a fulcrum portion. Each of the armportion and the anchor portion may define one or more apertures forreceiving fasteners that attach the bone plate to bone. The system alsomay comprise a thumbscrew including a graspable handle portion affixedto a shaft portion having an external thread. The shaft portion may beconfigured to be disposed in threaded engagement with an aperture of thearm portion, such that the handle portion projects from an outer surfaceof the arm portion, and such that the shaft portion projects from aninner surface of the arm portion, to enable support of the arm portionat a slant above a bone surface by the thumbscrew and the fulcrumportion of the bone plate.

The system disclosed herein has substantial advantages over bonefixation systems lacking a leg member. For example, the leg member mayreduce undesired plate movement while another portion of the bone plateis being attached to an end region of bone, permitting a surgeon to moreaccurately direct fasteners into bone, with less plate slippage. Also,the leg member may enable a surgeon to support an arm portion of a boneplate at a desired and/or predefined angle above a shaft region of abone, to introduce a corresponding change in angular disposition of theend region of a bone when the arm portion is moved into alignment withthe shaft region. Thus, the system may enable more accurate angularrepositioning of bone fragments in corrective osteotomy or duringreduction of a fractured bone.

Further aspects of the present disclosure are described in the followingsections: (I) overview of an exemplary bone fixation system with a legmember, (II) exemplary method of fixing a fractured bone, (III)exemplary method of bone fixation with corrective osteotomy, (IV) boneplates, (V) leg members, and (VI) selected embodiments.

I. Overview of an Exemplary Bone Fixation System with a Leg Member

FIG. 1 shows selected aspects of an exemplary bone fixation system 40including a bone plate 42 connected to a detachable leg member 44 thatprovisionally supports a portion of the bone plate in a spaced relationto a bone 46, particularly a shaft region (and/or a shaft fragment) 47of the bone. Here, bone 46 is a radial bone that has sustained afracture 47A, and fixation system 40 is disposed on a distal volarsurface region of the radial bone.

The bone plate has opposing outer and inner surfaces 48, 50 configuredto face, respectively, away from and toward bone 46. The plate bone isdepicted here in profile, which reveals an upward longitudinal bend.However, in other embodiments, the bone plate may have a substantiallylinear profile or a downward longitudinal bend, among others.

The bone plate may include an arm portion 52 (interchangeably termed alever portion), an intermediate or fulcrum portion 54, and an anchorportion 56 arranged in order along the bone plate. The arm portion maybe supported in a spaced relation to bone by a set of contacts providedcollectively by leg member 44 and fulcrum portion 54 and/or anchorportion 56. For example, fulcrum portion 54 (or anchor portion 56), dueto its width, may provide at least two points of contact with bone 46,and leg member 44 may provide at least one more point of contact withthe bone. In any event, leg member 44 may support arm portion 52 at aslant, in a spaced configuration from an adjacent surface area of bone46 (and shaft region 47), such that the bone plate and the bone divergeas arm portion 52 extends away from fulcrum portion 54. Accordingly, anacute angle 58 may be formed between arm portion 52 and shaft region 47and/or may be defined collectively by arm portion 52 and bone 46.

Leg member 44 may be attached to the arm portion of the bone plate, suchthat at least part of the leg member projects below the bone plate, in adirection transverse (e.g., substantially orthogonally) to the armportion. For example, the leg member may project from inner surface 50(and, optionally, outer surface 48) of the bone plate. The leg membermay be attached by any suitable mechanism that allows subsequentdetachment, such as threaded engagement with the arm portion, one ormore clips, a sleeve, a mated snap-fit, etc. The leg member may beattached to the bone plate near one of the plate's opposing ends 60, 62,such as the proximal end in the depicted embodiment. The leg member,when attached to the bone plate, may extend through an aperture 63 ofthe bone plate. The leg member may provide an upper portion 64projecting above outer surface 48 of the bone plate, an intermediateportion 66 locked to the bone plate in aperture 63, and a lower orspacer portion 68 that projects below inner surface 50 of the boneplate. Spacer portion 68 may extend to a distal tip 70, such as apointed or blunt tip, that contacts bone. The length of spacer portion68 and its distance of separation from fulcrum portion 54 (and/or anchorportion 56) of the bone plate generally determine the magnitude of acuteangle 58 at which arm portion 52 is supported relative to shaft region47 and how far an end (e.g., proximal end 60) of the bone plate isspaced from bone 46.

FIG. 2 shows a top view of bone plate 42, including arm portion 52,fulcrum portion 54, and anchor portion 56, and with leg member 44removed. (The perimeter of leg member 44 is shown in phantom outline.)Each of the arm portion and the anchor portion may define a plurality ofapertures 80 (e.g., through-holes) to receive fasteners (e.g., bonescrews, wires, a screw to attach a target guide or handle, etc.). Eachof the apertures may be locking (e.g., having an internal thread) ornonlocking (e.g., lacking an internal thread). At least one aperture inarm portion 52, such as aperture 63, may include a locking structure,such as an internal thread 82, adapted to provide locked engagement withan external thread of the leg member.

Bone plate 42 may be used to fix an end region 84 of bone 46 relative toshaft region 47. The bone plate may include a relatively wider headportion 86 connected to a relatively narrower body portion 88, which maybe elongated. Head portion 86 may be disposed closer to the end of thebone than body portion 88, such as distally on the radial bone, andcorresponds to anchor portion 56. The body portion may be disposed morecentrally along the bone, such as more proximally on the radial bone,and corresponds to arm portion 52. Fulcrum portion 54 of the bone platemay be disposed generally between head portion 86 and body portion 88.

FIGS. 3-7 show exemplary leg members 90-98 for use in fixation system 40with bone plate 42. Each leg member 90-98 is designed to support the armportion of the bone plate at a predefined angle of about 5°, 10°, 15°,20°, and 25°, respectively, with respect to an adjacent surface regionof bone. Each leg member may be marked with one or more indicia, such aswith one or more alphanumeric characters (e.g., a number, such as “15”),to identify the angle at which the leg member is configured to supportthe arm portion.

Each leg member 90-98 may be structured as a post member. The postmember may include a graspable handle or head portion 100 connected to arespective shaft portion 102-110, which may be of smaller width/diameterthan the handle/head portion. The handle portion may include a knurledsurface 112 with ridges formed on sides of the handle to facilitatemanual engagement (e.g., with a gloved (or ungloved) hand of a surgeon).The post member (e.g., the head and/or shaft portion) may form a stopstructure 114 (e.g., a shoulder) that blocks axial advancement of thepost member through an aperture of the bone plate. In other words, thestop structure may form an abutment with the bone plate that determinesa fully advanced position of the post member. In some embodiments, thepost member may be described as a thumbscrew, which may be any screwconfigured to be turned by hand via an integral, graspable head.

Each shaft portion of the post member may include an external thread116, which may extend along any suitable portion, a majority, or atleast substantially all of the length of the shaft portion. The shaftportion may (or may not) include a nonthreaded region 118 (e.g., seeFIGS. 5-7) and may extend to a distal tip 120 (see FIG. 3). The distanceof tip 120 from stop structure 114 is different for each post member ofFIGS. 3-8. This distance determines how much of the post member, andparticularly the shaft portion thereof, projects below the bone platewhen stop structure 114 is abutted with the bone plate, and thus theangle at which the arm portion of the bone plate is supported relativeto bone.

The post member may have a through-bore 124 extending lengthwise throughthe post member (see FIG. 7). The through-bore, which may be describedas a cannulation, may be utilized to receive a wire (such as a K-wire)that extends through the post member and, optionally, into bone. Thewire may help to hold the post member in place on the bone, may be usedto guide the post member on the bone, and/or may be visualized underfluoroscopy to project the axis defined by the post member into bone,among others.

FIG. 8 shows another exemplary leg member 130 structured as a postmember for use in system 40 with bone plate 42 (see FIG. 1). Leg member130 may be designed to support the arm portion of the bone plate at acontinuous range of angles from about 0° to 30°, based on how far athreaded shaft 132 of the leg member is advanced through the bone plate.If leg member 130 is advanced fully, such that stop structure 114engages the bone plate, the leg member may support the arm portion ofthe bone plate at about 30°.

The bone fixation system may be provided as a kit. The kit may includeat least one bone plate, one or more leg members, fasteners (e.g., bonescrews) to attach the bone plate to bone, a protractor, a saw forcutting bone, a guide device to guide a drill bit and/or fastenersthrough apertures of the bone plate and into bone, and/or the like. Insome embodiments, the kit may include a bone plate and a set of two ormore leg members that assemble interchangeably with the bone plate tosupport an arm portion of the bone plate at two or more predefinedangles, such as two or more predefined angles that differ from eachother by an increment of about 1, 2, 3, 4, or 5 degrees, or an integermultiple thereof, among others. The two or more leg members may be postmembers with shafts of different length. The components of a kit may besupplied in a sterile package. Some of the components may be configuredto be re-used (e.g., the protractor, saw, and guide device) and othersmay be configured to be used only once (e.g., the bone plate andfasteners).

The bone plate and leg members disclosed herein may be formed of anysuitable biocompatible material(s). Exemplary biocompatible materialsinclude (1) metals (for example, titanium or titanium alloys, alloyswith cobalt and chromium (cobalt-chrome), stainless steel, etc.); (2)plastics/polymers (for example, ultra-high molecular weight polyethylene(UHMWPE), polymethylmethacrylate (PMMA), polytetrafluoroethylene (PTFE),polyetheretherketone (PEEK), nylon, polypropylene, and/orPMMA/polyhydroxyethylmethacrylate (PHEMA)); (3) ceramics (for example,alumina, beryllia, and/or zirconia, among others); (4) composites (e.g.,a polymer matrix (such as PEEK) containing carbon fibers and/orceramic); (5) bioresorbable (bioabsorbable) materials or polymers (forexample, polymers of α-hydroxy carboxylic acids (e.g., polylactic acid(such as PLLA, PDLLA, and/or PDLA), polyglycolic acid, lactide/glycolidecopolymers, etc.), polydioxanones, polycaprolactones, polytrimethylenecarbonate, polyethylene oxide, poly-β-hydroxybutyrate,poly-β-hydroxypropionate, poly-δ-valerolactone, other bioresorbablepolyesters, etc.; and/or the like. In exemplary embodiments, both thebone plate and the leg members are formed of metal. For example, thebone plate may be formed of titanium (such as a titanium alloy) and theleg member of surgical grade stainless steel.

II. Exemplary Method of Fixing a Fractured Bone

FIGS. 9-13 show somewhat schematic configurations produced duringperformance of an exemplary method of fixing fractured bone 46 usingbone plate 42 and leg member 130 (see FIGS. 1 and 8). The method mayinclude any suitable combination of the steps disclosed in this sectionor elsewhere in the present disclosure, performed in any suitable order.In some embodiments, the method may reduce and fix a bone, such as aradial bone fractured distally.

A bone may be selected for fixation. The bone may have any suitablediscontinuity or may be a candidate for an osteotomy. Exemplary bonesthat may be selected are long bones, such as a femur, tibia, fibula,ulna, radius, humerus, or the like. In some embodiments, the bone mayinclude an end region that has an undesired angular disposition relativeto a shaft region of the bone. The undesired angular disposition may bethe result of displacement caused by fracture, a malunion, a growthdeformity, or the like.

A bone plate and a leg member may be selected. The leg member may becontinuously adjustable (e.g., leg member 130 of FIG. 8) and/or mayprovide a predefined angle of support. The leg member may be selectedfrom a set of two or more leg members that provide different predefinedangles of support and/or have spacer portions 68 (and/or shafts) ofdifferent length (see FIGS. 1 and 3-8). In some cases, a continuouslyadjustable leg member may be more suitable for fracture fixation.

Bone plate 42 and leg member 130 may be disposed on the bone such thatthe leg member is attached to the bone plate and spaces arm portion 52from the bone. The leg member may be attached to the bone plate beforeor after the bone plate is disposed on the bone. Accordingly, the boneplate and leg member may be assembled with each other off bone (e.g., bya manufacturer or peri-operatively) or on bone. The bone plate may bepositioned to span a discontinuity in the bone (such as fracture 47A)and/or a prospective osteotomy site.

FIG. 9 shows bone plate 42 and leg member 130 assembled with each otherand disposed on fractured bone 46. The leg member, which may bedescribed as a jackscrew, is locked to the bone plate. The leg membermay support arm portion 52 of the bone plate at a predefined slantrelative to shaft region 47 of bone 46.

End region 84 of the bone has been displaced at least in part byrotation out of alignment with shaft region 47 as a consequence offracture 47A. The bone plate may have an inner surface region (e.g.,provided by anchor portion 56) that is contoured to be complementary toan end surface region of bone 46 (e.g., on end region 84). The innersurface region of the bone plate thus may serve as a template forreconstruction of the bone. Accordingly, in some embodiments, leg member130 may be turned at this stage of the procedure, indicated at 140, tochange the acute angle formed between shaft region 47 and arm portion52, to adjust the fit of the inner surface region of anchor portion 56on end region 84. In other words, arm portion 52 may be raised orlowered, to pivot anchor portion 56 in order to improve the abutment ofanchor portion 56 and end region 84, at least in part by matching theangular disposition of end region 84 with that of anchor portion 56.Adjustment of the length of spacer portion 68 of leg member 130 thatprojects below the bone plate, while the leg member is supporting armportion 52, may produce coincident pivotal motion of arm portion 52 andanchor portion 56.

FIG. 10 shows an attached configuration of bone plate 42. Anchor portion56 may be attached to end region 84 of the bone while arm portion 52 issupported by leg member 130 and fulcrum portion 54. Attachment mayinclude placement of fasteners, indicated at 142 in FIG. 9, such as oneor more bone screws 144, through one or more apertures of the anchorportion and into end region 84 of the bone. During this procedure, theleg member may stabilize the position of the bone plate by restrictingpivotal and translational motion thereof. In some embodiments, anchorportion 56 may be attached to end region 84 before leg member 130engages shaft region 47 of bone 46.

FIG. 11 shows an adjustable configuration of the fractured bone in whichbone plate 42 is poised to function as a lever. Leg member 130 may bemanipulated, indicated at 146, to remove the support previously providedto the bone plate by the leg member. For example, in the presentillustration, the leg member has been disconnected from the bone plateand removed by unthreading the leg member from arm portion 52. As aresult, arm portion 52 can be urged toward shaft region 47 by pivotingthe arm portion, indicated by a motion arrow at 148. A fulcrum forpivotal movement may be formed by contact of the fulcrum portion of thebone plate with shaft region 47 near the fracture, with adjacent softtissue, and/or with one or more intermediate bone fragments, amongothers.

Motion of the arm portion adjusts an orientation of end region 84, asindicated by a motion arrow at 150. The motion may set the palmarinclination (also called the palmar tilt) of a distal articular surface152 of the radial bone. (The term “palmar” may be used as a synonym for“volar.”) The palmar inclination is defined as the angle between a firstline drawn perpendicular to the long axis of the radius and a secondline drawn between the dorsal and palmar lips of the distal radialarticular surface. An exemplary palmar inclination is about 12 degrees(with the dorsal lip disposed more distally than the palmar lip).

FIG. 12 shows a volar view of bone 46 with plate 42 attached to endregion 84, taken generally along line 12-12 of FIG. 11. Arm portion 52also may be moved pivotally, indicated by a motion arrow at 154, to seta radial inclination of distal articular surface 152 of bone 46. Theradial inclination is defined as the angle between a first line drawnperpendicular to the long axis of the radius at the outer corner of thelunate fossa of surface 152 and a second line drawn between the outercorner of the lunate fossa and the tip of the radial styloid. Anexemplary radial inclination is about 23 degrees.

FIG. 13 shows arm portion 52 attached to shaft region 47 to stabilizethe adjusted orientation of end region 84. The arm portion has beenpivoted into alignment with shaft region 47, such that the arm portionis no longer spaced and slanted with respect to the shaft region. Endregion 84 has been pivoted by a corresponding amount to an adjustedorientation that reduces the fractured bone by improving the alignmentof the shaft and end regions of the bone. Attachment may includeplacement of fasteners, such as one or more bone screws 156, through oneor more apertures of the arm portion and into the shaft region of thebone.

III. Exemplary Method of Bone Fixation with Corrective Osteotomy

FIGS. 14-16 show somewhat schematic configurations produced duringperformance of an exemplary method of fixing a cut bone using bone plate42 (FIGS. 1 and 2) and leg member 96 (FIG. 6). The method may includeany combination of the steps disclosed in this section or elsewhere inthe present disclosure, performed in any suitable order. In someembodiments, the method may be performed as part of a correctiveosteotomy. In an osteotomy, a bone is cut and then realigned, shortened,or lengthened to correct a defect. The method may be performed on any ofthe bones listed above in the preceding section. In the presentillustration, radial bone 46 is cut, realigned, and fixed.

A surgeon may estimate the amount of angular correction needed, andchoose the appropriate leg member from a set of leg members offeringdifferent angular corrections. In this example, leg member 96 isselected to provide a 20-degree correction. The leg member may be markedwith indicia 160 to facilitate identification of the leg member.

FIG. 14 shows bone plate 42 supported by leg member 96 proximally andbeing attached distally on the volar surface of radius 46 distally withbone screws 162. Bone plate 42 may be supported distally, prior toattachment with bone screws 162, by contact of radius 160 with fulcrumportion 54 and/or anchor portion 56 of the bone plate. FIG. 15 shows acut 164 placed through radius 46 proximal to secured anchor portion 56of the bone plate. The cut may be formed with a saw and may create adistal bone fragment (an end fragment) 166 and a main, proximal bonefragment (a shaft fragment) 168.

FIG. 16 shows bone plate 42 and radius 46 after removal of leg member 96and pivotal movement, indicated at 170 of arm portion 52 of the boneplate into alignment with shaft fragment 168. Pivotal movement of armportion 52 may also produce a corresponding pivotal movement of endfragment 166, indicated at 172. The leg member is designed to supportarm portion 52 at an angle of 20 degrees with respect to a shaft surfaceregion of radius 46. Accordingly, pivoting arm portion 52 through anangle of 20 degrees, to place the arm portion against proximal bonefragment 168, causes a corresponding rotation of 20 degrees of distalbone fragment 166, which may create a 20-degree gap 170. The arm portionthen may be secured to proximal fragment 168 of the radius withfasteners, such as bone screws 176, to fix the bone. The 20-degree gapmay be filled, for example, via natural healing and/or a bone graft, sothat the bone ends up with the desired shape.

IV. Bone Plates

A bone plate generally refers to any structure or piece having a plategeometry and being configured to be attached to bone with the bone plateat least mostly or completely under skin (and, generally, other softtissue). The bone plate may be configured to reduce irritation to thebone and surrounding soft tissue. For example, the bone plate may have alow and/or feathered profile to reduce its protrusion into overlyingsoft tissue and rounded, burr-free surfaces to reduce the effects ofsuch protrusion.

The bone plates of the present disclosure may have any shape suitablefor use on their intended target bones. The bone plate may be shaped foruse on any suitable bone or bones to be fixed, including a bone of thearms (such as a humerus, a radius, and/or an ulna), a bone of the legs(such as a femur, a tibia, and/or a fibula), a bone of the hands (suchas a carpal, metacarpal, and/or phalange), a bone of the feet (such as atarsal, metatarsal, and/or phalange), a clavicle, a rib, a scapula, apelvic bone, a vertebra, a skull, a mandible, or the like.

Each bone plate may be configured for use on any suitable side or sidesof the body. For example, the bone plate may be configured for use onboth the left side and right side of the body/skeleton, such as when thebone plate is bilaterally symmetrical. Alternatively, each bone platemay be configured for use on either the left side or right side of thebody/skeleton, but not both.

Each bone plate may have any suitable contour. In some examples, thebone plate may be supplied in a pre-contoured configuration producedduring plate manufacture (e.g., by bending, molding, and/or machining,among others) to include an inner surface region that is complementaryto a nonplanar surface region of a target bone. The bone plate thus maybe pre-contoured according to an average or representative surfacegeometry of a target bone. Alternatively, or in addition, the bone platemay be contoured peri-operatively (e.g., by bending the bone plate), toadjust its shape before and/or during its installation on bone, toimprove, for example, the fit of the bone plate on a target bone forparticular individuals and/or on distinct regions of the target bone.

Each bone plate may be generally elongate, with length L>widthW>thickness T. In use, the long axis of the bone plate may be alignedwith the long axis of a target bone and/or may extend obliquely and/ortransversely relative to the long axis. In some embodiments, the boneplate may have a length and a width that are about the same.

Each bone plate may be of continuous structure (e.g., monolithic) or mayinclude two or more discrete pieces. The two or more discrete pieces maybe fixed to one another or may be connected through a mechanical jointthat enables translational and/or pivotal movement to adjust the shapeand/or size of the bone plate.

The bone plate may include a first portion and a second portion, whichmay be arranged along the bone plate from each other. Each of the firstportion and the second portion may be anchor portion (i.e., anattachment portion) defining one or more apertures for receivingfasteners that secure the anchor portion to bone. At least one of theanchor portions also may be described as an arm portion, a head portion,and/or a body portion, among others. An arm portion is any part of abone plate that is supportable in a spaced relation to bone and then canbe pivoted toward the bone.

V. Leg Members

The bone fixation systems disclosed herein utilize a leg member totemporarily support part of a bone plate in a spaced relation to bone,such as at a slant above a shaft region of a bone. A leg membergenerally comprises any detachable support that can prop up an endregion of a bone plate while the opposing end region is being attachedto bone. A leg member projects below an inner surface of the bone plateby any suitable distance. The leg member may project orthogonally orobliquely from the inner surface. In some cases, the leg member or aportion thereof may be described as a jackscrew, a stand, a bolt, apost, a kickstand, or a combination thereof.

The leg member may have any suitable shape. The leg member may beelongate. The leg member or regions thereof may or may not be at leastgenerally cylindrical. For example, the leg member may include acylindrical head/handle portion, a cylindrical shaft portion thatextends through the bone plate and/or projects below the bone plate, ora combination thereof, among others.

Any suitable connection may be formed between the leg member and a boneplate. The leg member may be locked to the bone plate, such that axialmotion of the leg member is restricted in both axial directions of theleg member. Alternatively, the leg member may support part of the boneplate without locked engagement. For example, the leg member may providea post with a flange on which the bone plate rests, such that the flangerestricts separation of the leg member from the bone plate in only oneof two axial directions of the leg member. In other embodiments, the legmember may slide onto the bone plate from an end thereof, may clip ontothe bone plate, or the like.

VI. Selected Embodiments

This section describes selected embodiments of the present disclosure,presented as a series of indexed paragraphs. These embodiments areintended for illustration and should not limit the entire scope of thepresent disclosure.

1. A method of bone fixation, comprising: (A) supporting an arm portionof a bone plate in a spaced relation to a shaft region of a bone with aleg member connected to the arm portion and engaged with the shaftregion; (B) attaching an anchor portion of the bone plate to an endregion of the bone; (C) manipulating the leg member to remove the legmember's support of the arm portion; (D) moving the arm portion towardthe shaft region of the bone to adjust an orientation of the end regionof the bone; and (E) attaching the arm portion to the shaft region tostabilize the adjusted orientation.

2. The method of paragraph 1, further comprising a step of disposing theleg member in threaded engagement with the arm portion.

3. The method of paragraph 2, wherein the leg member includes a handleportion, and wherein the step of disposing the leg member in threadedengagement includes a step of turning the handle portion with the handleportion grasped manually.

4. The method of paragraph 1, wherein the step of supporting includes astep of supporting the arm portion with the leg member at a predefinedangle with respect to the shaft region.

5. The method of paragraph 4, further comprising a step of selecting theleg member from a set of two or more leg members providing differentpredefined angles of support for the arm portion.

6. The method of paragraph 4, wherein the leg member has a positionwhere advancement through an aperture of the bone plate is stopped, andwherein the position provides the predefined angle.

7. The method of paragraph 6, wherein the leg member includes a head anda shaft, and wherein the position is achieved when the head engages thearm portion.

8. The method of paragraph 1, wherein the step of supporting includes astep of supporting the arm portion at a slant with respect to the shaftregion, and wherein the leg member is configured to be adjustable toprovide a continuous range of angles for the slant.

9. The method of paragraph 8, further comprising a step of adjusting theslant to provide a better fit of the anchor portion on the end region ofthe bone.

10. The method of paragraph 1, further comprising a step of cutting thebone to separate the shaft region from the end region before the step ofmoving.

11. The method of paragraph 1, wherein the shaft region and the endregion of the bone are separated by a fracture in the bone.

12. The method of paragraph 1, wherein the step of manipulating includesa step of unthreading the leg member from the arm portion.

13. The method of paragraph 1, wherein the step of moving includes astep of pivoting the arm portion of the bone plate.

14. A system for bone fixation, comprising: (A) a bone plate includingan anchor portion and an arm portion each defining one or moreapertures; and (B) a leg member including a graspable handle portionconnected to a shaft portion, the shaft portion being configured to bedisposed in threaded engagement with an aperture of the arm portion ofthe bone plate, with the handle portion projecting above the bone plate,such that part of the shaft portion extends below the bone plate topermit support of the arm portion of the bone plate in a spaced relationto a shaft region of a bone.

15. A system for bone fixation, comprising: (A) a bone plate includingan anchor portion and an arm portion each defining one or more aperturesand also including a fulcrum; and (B) a post member including a handleportion connected to a shaft portion, the shaft portion being configuredto be disposed in threaded engagement with an aperture of the armportion of the bone plate such that part of the shaft portion extendsbelow the bone plate to provide support of the arm portion of the boneplate at a predefined angle and such that the handle portion projectsabove the bone plate.

16. A system for bone fixation, comprising: (A) a bone plate includingan anchor portion and an arm portion each defining one or moreapertures; and (B) at least two posts each including a head portionconnected to a shaft portion, each shaft portion being configured to bedisposed in threaded engagement with an aperture of the arm portion ofthe bone plate such that part of the shaft portion extends below thebone plate to provide support of the arm portion of the bone plate at apredefined angle, wherein the leg members are configured to providedifferent predefined angles of support.

17. A method of fixing bone, comprising: (A) selecting a bone plateincluding a first portion and a second portion; (B) disposing the boneplate and a discrete leg member on the bone such that the leg member isattached to and projects from the first portion of the bone plate to afirst region of the bone, to position the first portion of the boneplate at a slant with respect to the first region and spaced from thebone; (C) attaching the second portion of the bone plate to a secondregion of the bone; (D) pivoting the first portion of the bone platetoward the first region of the bone such that the bone plate is used asa lever to change an orientation of the second region relative to thefirst region of the bone; and (E) attaching the first portion of thebone plate to the first region of the bone.

18. The method of paragraph 17, wherein the step of disposing positionsthe first portion at a predefined angle with respect to the first regionof the bone.

19. The method of paragraph 18, wherein the leg member has a stopstructure that blocks advancement through an aperture of the firstportion of the bone plate at a position of the leg member.

20. The method of paragraph 19, wherein stop structure is a shoulderformed by the leg member.

21. The method of paragraph 17, further comprising a step of selectingthe leg member from a set of two or more leg members each extending adifferent predefined distance from the first portion when attached tothe bone plate.

22. The method of paragraph 17, wherein the leg member is configured tobe adjustably advanced with respect to the arm portion to provide acontinuous range of angles for the slant of the first portion of thebone plate.

23. The method of paragraph 17, wherein the first region is a shaftregion and the second region is an end region of the bone,

24. The method of paragraph 23, further comprising a step of cutting thebone to separate the shaft region from the end region before the step ofpivoting.

25. The method of paragraph 23, wherein the shaft region and the endregion of the bone are separated by a fracture in the bone.

26. A system for bone fixation, comprising: (A) a bone plate includingan arm portion and an anchor portion separated from the arm portion by afulcrum portion, each of the arm portion and the anchor portion definingone or more apertures for receiving fasteners that attach the bone plateto bone; and (B) a thumbscrew including a graspable handle portionaffixed to a shaft portion having an external thread, the shaft portionbeing configured to be disposed in threaded engagement with an apertureof the arm portion, such that the handle portion projects from an outersurface of the arm portion, and such that the shaft portion projectsfrom an inner surface of the arm portion, to enable support of the armportion at a slant above a bone surface by the thumbscrew and thefulcrum portion of the bone plate before use of the bone plate as alever.

27. The system of paragraph 26, wherein the thumbscrew is in threadedengagement with the aperture and restricted from further advancementinto the aperture, and wherein a projecting region of the shaft portionprojects into air from the inner surface of the arm portion to a distaltip of the shaft portion.

28. The system of paragraph 26, wherein the graspable handle portion ofthe thumbscrew is substantially permanently affixed to the shaftportion.

29. The system of paragraph 26, wherein the graspable handle portion iscylindrical.

30. The system of paragraph 26, wherein the graspable handle portionincludes a knurled surface region.

31. The system of paragraph 26, wherein the thumbscrew defines a longaxis, and wherein the graspable handle portion is elongated in adirection parallel to the long axis.

32. The system of paragraph 26, wherein the thumbscrew is a firstthumbscrew, further comprising a second thumbscrew configured to bedisposed in threaded engagement with the aperture of the arm portion ofthe bone plate, and wherein each of the first and second thumbscrews isconfigured to support the arm portion at a respective differentpredefined angle of slant when fully advanced into the aperture.

33. The system of paragraph 32, wherein the predefined angle of slantfor the first thumbscrew and the second thumbscrew differ from eachother by about five or ten degrees.

34. The system of paragraph 32, wherein each of the first and secondthumbscrews is marked with at least one indicium identifying an angle ofslant at which the thumbscrew supports the arm portion.

35. The system of paragraph 26, wherein the anchor portion is wider thanthe arm portion.

36. The system of paragraph 26, wherein the anchor portion has an innersurface that is contoured to match a surface region near an end of abone, such that the anchor portion fits onto the surface region.

37. The system of paragraph 36, wherein the anchor portion has an innersurface that is contoured to match a surface region near a distal end ofa radial bone.

38. The system of paragraph 37, wherein the bone plate has alongitudinal bend that renders an outer surface of the bone plate atleast substantially concave in profile.

The disclosure set forth above may encompass multiple distinctinventions with independent utility. Although each of these inventionshas been disclosed in its preferred form(s), the specific embodimentsthereof as disclosed and illustrated herein are not to be considered ina limiting sense, because numerous variations are possible.

The subject matter of the inventions includes all novel and nonobviouscombinations and subcombinations of the various elements, features,functions, and/or properties disclosed herein. The following claimsparticularly point out certain combinations and subcombinations regardedas novel and nonobvious. Inventions embodied in other combinations andsubcombinations of features, functions, elements, and/or properties maybe claimed in applications claiming priority from this or a relatedapplication. Such claims, whether directed to a different invention orto the same invention, and whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the inventions of the present disclosure.Further, ordinal indicators, such as first, second, or third, foridentified elements are used to distinguish between the elements, and donot indicate a particular position or order of such elements, unlessotherwise specifically stated.

We claim:
 1. A method of fixing bone, comprising: selecting a bone plateincluding a first portion and a second portion; disposing a leg memberon the bone with the leg member attached to and projecting from thefirst portion of the bone plate to a first region of the bone, such thatthe first portion of the bone plate is supported at a slant with respectto the first region and spaced from the bone; attaching the secondportion of the bone plate to a second region of the bone; disconnectingthe leg member from the bone plate; pivoting the first portion of thebone plate toward the first region of the bone such that the bone plateis used as a lever to change an orientation of the second regionrelative to the first region of the bone; and attaching the firstportion of the bone plate to the first region of the bone.
 2. The methodof claim 1, wherein the bone plate includes a third portion disposedalong the bone plate between the first portion and the second portion,and wherein the step of disposing results in collective support of thefirst portion of the bone plate above the first region of the bone bythe leg member and the third portion of the bone plate.
 3. The method ofclaim 1, wherein the leg member is a post member, further comprising astep of disposing the post member in threaded engagement with anaperture defined by the first portion of the bone plate.
 4. The methodof claim 3, wherein the post member is a thumbscrew.
 5. The method ofclaim 1, wherein the first region includes at least one fragmentcontaining a majority of a shaft of a bone and the second regionincludes at least one end fragment of the bone.
 6. The method of claim1, wherein the step of pivoting includes a step of placing the firstportion of the bone plate against a bone and at least generally parallelto a long axis defined by the bone.
 7. The method of claim 1, whereinthe step of disconnecting the leg member is performed before the step ofpivoting.
 8. A method of fixing bone, comprising: selecting a bone plateincluding an elongated body portion connected to a head portion that iswider than the body portion; disposing a leg member on the bone with theleg member attached to and projecting from the body portion of the boneplate to a shaft region of the bone, such that the body portion of thebone plate is supported at a slant above the shaft region; attaching thehead portion of the bone plate to an end region of the bone;disconnecting the leg member from the bone plate; pivoting the bodyportion of the bone plate toward the shaft region of the bone such thatthe bone plate is used as a lever to change an orientation of the endregion relative to the shaft region of the bone; and attaching the bodyportion of the bone plate to the shaft region of the bone.
 9. The methodof claim 8, wherein the bone is a radial bone, and wherein the step ofpivoting adjusts a palmar inclination of a distal articular surfaceregion of the radial bone.
 10. The method of claim 9, further comprisinga step of adjusting a radial inclination of the distal articular surfaceregion by moving the body portion.
 11. The method of claim 8, whereinthe head portion has an inner surface that is contoured to match asurface region on the end region of the bone.
 12. The method of claim11, further comprising a step of adjusting an angle of slant of the bodyportion to provide a better fit of the head portion of the bone plate onthe end region of the bone.
 13. The method of claim 12, wherein the stepof adjusting an angle of slant of the body portion includes a step ofturning the leg member, a step of replacing the leg member with adifferent leg member, or a combination thereof.
 14. A method of fixingbone, comprising: selecting a bone plate including an arm portion, afulcrum portion, and an anchor portion arranged in order along the boneplate; disposing a post member on the bone with the post memberextending through an aperture of the arm portion to a first region ofbone and attached to the arm portion at the aperture, such that thefulcrum portion and the post member collectively support the arm portionin a spaced relation to the bone and at a slant with respect to thefirst region of the bone; attaching the anchor portion of the bone plateto a second region of the bone; disconnecting the leg member from thebone plate; pivoting the arm portion of the bone plate toward the firstregion of the bone such that the bone plate is used as a lever to changean orientation of the second region relative to the first region of thebone; and attaching the arm portion of the bone plate to the firstregion of the bone.
 15. The method of claim 14, wherein the post memberis attached to the aperture of the arm portion by threaded engagement.16. The method of claim 14, wherein the post member includes a headconnected to a shaft including an external thread, wherein the apertureof the arm portion is configured to receive the shaft but not the head,and wherein the head projects from an outer surface of the arm portionwhen the post member is fully advanced into the aperture.
 17. The methodof claim 16, wherein the head is a handle portion configured to begrasped by hand.
 18. The method of claim 17, wherein the handle portionis cylindrical and has a knurled surface region.
 19. The method of claim14, wherein the post member is a thumbscrew.
 20. The method of claim 14,wherein the post member has a stop structure that blocks advancement ofthe post member through the aperture of the arm portion.